期刊
SCHIZOPHRENIA RESEARCH
卷 138, 期 1, 页码 18-28出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.schres.2012.03.018
关键词
Combinations; Schizophrenia; Polypharmacy; Cotreatment; Meta-regression
类别
资金
- Zucker Hillside Hospital-National Institute of Mental Health (Advanced Center for Intervention and Services Research for the Study of Schizophrenia) [MH 074543-01]
- Albert Einstein College of Medicine CTSA from the National Center for Research Resources (NCRR), National Institutes of Health (NIH) [UL1 RR025750, KL2 RR025749, TL1 RR025748]
- NIH roadmap for Medical Research
- BMS
- Feinstein Institute for Medical Research
- Janssen/JJ
- National Institute of Mental Health (NIMH)
- National Alliance for Research in Schizophrenia and Depression (NARSAD)
- Otsuka
Objective: To assess the prevalence and correlates of antipsychotic polypharmacy (APP) across decades and regions. Methods: Electronic PubMed/Google Scholar search for studies reporting on APP, published from 1970 to 05/2009. Median rates and interquartile ranges (IQR) were calculated and compared using non-parametric tests. Demographic and clinical variables were tested as correlates of APP in bivariate and meta-regression analyses. Results: Across 147 studies (1,418,163 participants, 82.9% diagnosed with schizophrenia [IQR=42-100%]), the median APP rate was 19.6% (IQR=12.9-35.0%). Most common combinations included first-generation antipsychotics (FGAs) + second-generation antipsychotics (SGAs) (42.4%, IQR=0.0-71.4%) followed by FGAs + FGAs (19.6%, IQR=0.0-100%) and SGAs + SGAs (1.8%, IQR=0.0-28%). APP rates were not different between decades (1970-1979:28.8%, IQR=7.5-44%; 1980-1989:17.6%, IQR=10.8-38.2; 1990-1999:22.0%, IQR=11-40; 2000-2009:19.2% IQR=14.4-29.9, p=0.78), but between regions, being higher in Asia and Europe than North America, and in Asia than Oceania (p<0.001). APP increased numerically by 34% in North America from the 1980s 12.7%) to 2000s (17.0%) (p=0.94) and decreased significantly by 65% from 1980 (55.5%) to 2000 (19.2%) in Asia (p=0.03), with non-significant changes in Europe. APP was associated with inpatient status (p<0.001), use of FGAs (p<0.0001) and anticholinergics (<0.001), schizophrenia (p=0.01), less antidepressant use (p=0.02), greater LAIs use (p=0.04), shorter follow-up (p=0.001) and cross-sectional vs. longitudinal study design (p=0.03). In a meta-regression, inpatient status (p<0.0001), FGA use (0.046), and schizophrenia diagnosis (p=0.004) independently predicted APP (N=66, R-2=0.44, p<0.0001). Conclusions: APP is common with different rates and time trends by region over the last four decades. APP is associated with greater anticholinergic requirement, shorter observation time, greater illness severity and lower antidepressant use. (C) 2012 Elsevier B.V. All rights reserved.
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